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ARCHIVED REPORTS_XR0009178
Environmental Health - Public
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EHD Program Facility Records by Street Name
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P
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PERSHING
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4501
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3500 - Local Oversight Program
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PR0545651
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ARCHIVED REPORTS_XR0009178
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Entry Properties
Last modified
5/6/2020 11:36:08 AM
Creation date
5/6/2020 11:22:00 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0009178
RECORD_ID
PR0545651
PE
3528
FACILITY_ID
FA0002479
FACILITY_NAME
7-ELEVEN INC #17334
STREET_NUMBER
4501
Direction
N
STREET_NAME
PERSHING
STREET_TYPE
AVE
City
STOCKTON
Zip
95207
APN
11017004
CURRENT_STATUS
02
SITE_LOCATION
4501 N PERSHING AVE
P_LOCATION
01
P_DISTRICT
002
QC Status
Approved
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LSauers
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EHD - Public
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• Chain of Custody Number �7 G,.�� • <br /> SECQR Chain-of Custody Record <br /> [,Field Office 077 Sacramento ❑ Additional documents are attached, and are part of this Record <br /> Address 3017 Kilgore Road,Suite 100 Job Name 7-Eleven Store#17334 <br /> Rancho Cordova,CA Location 4501 North Pershing Avenue <br /> Stockton,CA <br /> Project# 77EL 17334 03 Task# 0410 Analysis Request <br /> Project Manager Jaff Auchterlonie <br /> Laboratory Kiff Ana itcal n _ <br /> Turnaround Time Standard a = <br /> m = EL Q c 2 <br /> Sampler's Name Tom Mlller S m c <br /> a <br /> Sampler's Signature a g o N m <br /> �' 1 3 Comments/ <br /> Sample ID Date Time Matrix $ w i2 h u Instructions z <br /> MW-2 Cbz NYU Water X X pt <br /> MW-3 S-/:)91-L 17/ Water X X <br /> Mw-5B sly c/o k (Sob Water X X 143 <br /> Mw-4 V2 oa i8 2 water X I X °`t <br /> MW5A Water X X o 5 <br /> Special Instructions/Comments Relinquished by �. i Received by Sample Receipt <br /> 5 Oxygenates TAME, MtBE, EtBE,TBA,DIPE Sign Sign Total no of containers <br /> 4 Global ID#T0607700407(SIRC) Pnnt � ; .rr,���..r Print Chain of custody seals <br /> EDF Deliverables Company ,CG, Cc oa n- Compo Recd in good conddion/cold <br /> email results to bcarey@seeor com Time Date Tim Date Conforms to record <br /> Relinquished by Received!Apyf N � <br /> Sign Sign Client SECOR <br /> Print Print S P Cluent Contact Brian Carey <br /> Compan Company , Client Phone 918 861-0430 <br /> Ti Date Time I S 0 6 Date 0 Z t ot-� ext 241 � <br /> Date Page a <br />
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